Biomedical subjects

C H Shih

Publications and source records attributed to C H Shih.

At least 109 records · Page 6Linked to original sources

PubMed1994

Localized femoral osteolysis in cementless ceramic total hip arthroplasty.

A retrospective review revealed localized femoral osteolysis occurred in 8 out of 134 cementless ceramic total hip arthroplasties (6.0%) performed during an average 9-year period. The average latent period was 8 years. The lesion was usually located in the deeper periprosthetic area. Localized osteolysis usually occurred after loosening of the femoral stem, suggesting the pathogenesis may be a foreign-body reaction to the ceramic debris.

Adult↗

PubMed1994

Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach.

Intercondylar fractures of the distal humerus in adults are rare and notoriously difficult to treat. The goals of open reduction are to preserve the articular surface and restore elbow function. We treated 20 patients by open reduction with dual-plate internal fixation and routine anterior subcutaneous transposition of the ulnar nerve. The follow-up period ranged from 15 to 35 months. The fractures were classified according to Muller's system. The results were evaluated using the Cassebaum rating system and subjective functional status. Excellent or good results were achieved in 15 elbows (75%), two had a fair result, and three, poor. A clearer understanding of fracture patterns, rigid dual-plate internal fixation, and early rehabilitation are needed to improve the results from this vexing injury. We recommended routine ulnar nerve anterior subcutaneous transposition using a posterior approach. Compared with published reports, our preliminary results demonstrated no postoperative ulnar nerve compression syndrome at follow-up. Routine anterior subcutaneous transposition of the ulnar nerve to avoid the postoperative ulnar nerve compression syndrome is required.

Adult↗

PubMed1994

Semiopen cancellous bone grafting. A 2 step method for closing small infected tibial bone defects.

Thirteen infected small tibial bone defects with overlying skin loss were treated with a 2 stage procedure. In the 1st stage, antibiotic impregnated polymethylmethacrylate bead chains were used to obliterate the debrided osseous cavity and a meshed porcine skin graft was used for temporary wound coverage. In the 2nd stage, the bead chains were replaced with autogenous cancellous bone graft, and the wound was again covered with a meshed porcine skin graft. All wounds and bone grafts healed without the need for an additional autogenous skin or bone graft. The patients were hospitalized an average of 23 days. The length of time to the completion of secondary epithelialization of the wound ranged from 2 to 5 months (average, 3 months). The length of time to bone union ranged from 5 to 8 months (average, 6.4 months). An additional application of porcine skin graft was required in 3 patients. Minor pin tract infections were seen in 2 patients. There was no recurrence of osteomyelitis during an average followup of 37 months (range, 24-54 months). This method was helpful in securing the closure of infected tibial bone defects with small skin losses and avoided both prolonged hospitalization and the morbidity usually accompanying free tissue transfer or the Papineau method of open cancellous bone grafting.

Adolescent↗

PubMed1994

Coracoid process fracture combined with acromioclavicular dislocation and coracoclavicular ligament rupture. A case report and review of the literature.

A coracoid process fracture associated with acromioclavicular joint dislocation and with rupturing of the coracoclavicular ligaments of an adult has been reported only once in the literature. This report adds another unusual case to the literature to reemphasize the importance of recognizing this unusual lesion. Two separate mechanisms--direct trauma to the shoulder girdle and sudden pull on the coracoid process by the conjoined tendons of short head biceps and coracobrachialis muscles--appear to be responsible for this unusual triple lesion. Open reduction with coracoid screw and acromioclavicular fixation, combined with an All-dredge repair to replace the ruptured coracoclavicular ligaments, resulted in an excellent outcome.

Acromioclavicular Joint↗

PubMed1994

Muscular recovery around the hip joint after total hip arthroplasty.

A prospective study was conducted to quantitatively measure the relative muscle torque strengths in 20 consecutive women with unilateral osteoarthritic hips and 20 consecutive men with unilateral osteonecrotic hips before and after primary cementless total hip arthroplasty. Maximal isometric torque strengths in the muscles of flexion, extension, and abduction around the hip joint were measured preoperatively and postoperatively at six months and one year, using a Cybex 340 dynamometer. The results showed improved muscle function after total hip arthroplasty in both diseased and healthy hips. In the diseased hips, all muscle groups improved significantly, from 150 to 250% of the preoperative levels, at six months and one year postoperatively, except in the osteoarthritic women, in whom the improvement at six months was minimal. Preoperatively, all muscle groups in the diseased hips were weaker than those in the uninvolved hips, especially in the osteonecrotic men (51-79% of healthy side). In both groups, however, the torques strengths of the diseased hips had not caught up to the healthy hips in the one-year follow-up period (84-89% in the osteonecrotic male group, and 79-81% in the osteoarthritic female group). The authors recommended that muscle strengthening exercises for the hip should be continued for at least one year, and perhaps longer, after total hip arthroplasty.

Adult↗

PubMed1993

Selection bias from differential residential mobility as an explanation for associations of wire codes with childhood cancer.

Several studies of childhood cancer, especially leukemia, in residential areas have reported an association with wire configuration codes. These codes were suggested to be surrogates of electromagnetic field exposure. However, the selection criteria used in several of the studies caused the case and control populations to be non-comparable, especially with respect to residential mobility. Specifically, controls were required to be residentially stable but cases were not. Thus, an artificial association between residential mobility and cancer was created by the subject selection procedure. The present study of 5721 residences in Columbus, Ohio was conducted to learn if bias due to differences in residential mobility, rather than electromagnetic fields, could explain the reported association between wire configuration codes and childhood cancer. It was found that the proportion of homes classified as "high" wire code in the non-stable population was 31% greater than the corresponding proportion in the stable population. This finding shows that high wire codes are associated with homes in which the residents are mobile and low wire codes are associated with homes occupied by stable residents. Thus, as a consequence of this association between residential mobility and high wire codes, studies that created an artificial association between residential mobility and childhood cancer will also produce a false association between high wire codes and cancer.

Case-Control Studies↗

PubMed1993

Segmental tibial shaft fractures treated with interlocking nailing.

Thirty-eight segmental tibial shaft fractures were treated with closed Grosse-Kempf interlocking nails and retrospectively followed up for > or = 1 year (average 32 months). There was a 97% union rate and a 4.5 +/- 1.6 month union period. Knee as well as ankle range of motion was satisfactory. Significant complications included one aseptic nonunion (3%), which healed after the static locked nail was dynamized. We recommend that whenever possible, closed interlocking nailing should be used to treat closed or mild open (wound size < 1 cm) segmental tibial shaft fractures.

Adolescent↗

PubMed1993

Femoral shaft fractures complicated by fracture-dislocations of the ipsilateral hip.

A series of 16 consecutive adults with femoral shaft fractures complicated by fracture-dislocations of the ipsilateral hip joint was prospectively studied. There were 11 posterior dislocations and five central dislocations. The treatment consisted of early closed reduction of the dislocation with the assistance of an external fixator, delayed reamed intramedullary nailing of the femoral fracture, and conservative or surgical treatment of the hip joint according to the indications. The follow-up period was 2-8 years (median, 3.5 years). Although an 18.8% (3 of 16) complication rate was noted, the outcome was satisfactory for all 16 hip joints. When such complicated combined injuries are sustained, the technique described here is the most reasonable treatment.

Adolescent↗

PubMed1993

Femoral shaft fractures associated with unstable pelvic fractures.

From December 1986 to December 1989, 23 consecutive adult patients with femoral shaft fractures associated with unstable pelvic fractures were prospectively studied. The mortality rate was 8.7%. An anterior frame of an external fixator was sometimes inserted emergently in patients with multiple injuries to improve their bedside care. Early reamed femoral intramedullary nailing accompanying closed or open reduction with internal fixation, external fixation or both for unstable pelvic fractures was the favored treatment method. Twenty cases were followed for an average of 26 months. The union rate was high (95%) and the complication rate was low (5%). Hip and knee joint function was also satisfactory. Combined femoral shaft and unstable pelvic fractures are severe injuries and necessitate aggressive emergent management. With the techniques described, patients can achieve optimal outcome.

Adolescent↗

PubMed1993

Complicated open fractures of the distal tibia treated by secondary interlocking nailing.

From January 1987 through December 1990, 28 consecutive distal tibial complicated open fractures in adults treated with primary external fixation and secondary closed Grosse-Kempf interlocking nails were prospectively studied and followed up for at least 1 year. All fractures were type IIIb open fractures and local soft-tissue coverage was performed at 3 to 5 days. The external fixation was maintained for an average of 22 days. The closed interlocking nails were inserted about 2 weeks after Hoffmann pins were removed. The results revealed a union rate of 85.7% (24 of 28) with a period to union of 5.8 +/- 1.4 months. Complications included 14.3% nonunion rate and a 7.2% deep infection rate, which were not difficult to treat. We conclude that secondary closed interlocking nailing is a simple and effective technique in treating distal tibial complicated open fractures.

Adult↗

PubMed1993

Simultaneous dislocation of the five carpometacarpal joints with concomitant fractures of the tuberosity of the trapezium and the hook of the hamate: case report.

Multiple carpometacarpal dislocations, with fractures of the trapezium and hook of the hamate carpals are rare. We report an exceedingly rare constellation of these injuries. The routine use of a carpal tunnel view is advised to identify the associated avulsion fractures with multiple carpometacarpal dislocations. We found little on this subject in existing papers. It is important because painful nonunion of avulsion fractures and compressive ulnar or median neuropathy may be ignored and thus not receive suitable treatment.

Adult↗

PubMed1993

Treatment of recurrent adamantinoma of the tibia by wide resection: report of three cases.

Three cases of recurrent adamantinoma of the tibia were treated by wide resection and frozen allograft reconstruction. After an average follow-up period of 4.5 years (from 3.5 to 5.5 years), all allografts were found to have united to both ends of the host bone and none of the patients suffered further recurrence. According to Enneking's criteria for functional evaluation, two patients had excellent results and one had a good result. Therefore, it appears that amputation is not the only solution for recurrent adamantinoma of the long bone. In selected cases, wide resection and allograft replacement can achieve a satisfactory result.

Adult↗

PubMed1993

Allograft transplantation in aggressive or malignant bone tumors.

Twenty-three patients with aggressive benign or malignant bone tumors had segmental allograft replacements after resection of the tumors. The mean age of the patients was 30 years of age. The mean length of the allografts was 14 cm. The allografts consisted of intercalary allograft (5), allograft arthrodesis (12), and allograft-prosthetic composite (6). Intramedullary fixation with or without additional compression plate was used to osteosynthesize all the osteotomy sites with the exception of one in which a long nail plate was used. A supplement of autogeneic bone grafts at the allograft-host junction was performed in 18 patients. Seven patients received preoperative and postoperative chemotherapy for high grade sarcomas. At an average follow-up period of four years, 78% of the patients had excellent or good results. The union rate of the grafts was 86%. Supplement with autografts shortened the union time of the allograft from 15 to eight months. One patient had a tumor recurrence and one died of the disease. Other complications included one delayed union, two nonunions of the allograft, two late infections, and one neuropathy. Allograft transplantation is an acceptable method for tumor reconstruction. The adjuvant chemotherapy did not have significant adverse effects on its outcome. Complications that relate to allografting are common, but most of them are salvageable.

Adult↗

PubMed1993

Acute septic arthritis of the hip in children--clinical analyses of 31 cases.

This is a retrospective study of 31 cases of acute septic arthritis of the hip in children treated at Chang Gung Memorial Hospital from 1983 to 1989. The average follow-up period was 35 months. Among them, there were 18 males (58%) and 13 females (42%). None were involved bilaterally. Fifteen cases (48%) were below 5 years of age. All cases met the diagnostic criteria including bacteriological results, clinical and radiographic changes. Limited range of motion, fever, and tenderness were the most common symptoms and signs. More than half of the patients (52%) had a leukocyte count of over 15,000/cmm. The erythrocyte sedimentation rate was elevated in 30 cases (97%). Pathogens had been isolated from blood, arthrocentesis fluid, or surgical specimens in 26 cases (84%). Staphylococcus aureus was the most common causative organism (58%). Twenty-seven cases (87%) underwent emergency arthrotomy and debridement. Five (19%) of them received unsatisfactory results. A delay in definite treatment, very young infants, and the association with osteomyelitis of the adjacent bone were the important factors associated with poor prognosis. Four cases (13%) who received only medical treatment showed satisfactory results. Early diagnosis and significant response to antibiotics contributed to this favorable outcome.

Acute Disease↗

PubMed1993

Monteggia fractures in adults.

From January 1978 to December 1989, 60 adult acute Monteggia fractures were treated and followed-up for at least one year (average 3 years 9 months). Ulnar fractures were treated with open reduction and internal fixation with a dynamic compression plate or a Rush pin, and 2 with minimal ulnar displacement were treated with closed reduction. Forty radial heads had a closed reduction, 6 required an open reduction with annular ligament repair or fascial reconstruction, and 14 were resected due to comminution. The results showed a 90% union rate with a 3.5 +/- 1.2 months union period. Functional evaluation revealed a 78% satisfactory rate. The unsatisfactory results were associated with severe soft tissue injury which restricted elbow range of motion, persistent posttraumatic neurological deficit of brachial plexus injury and subluxation or redislocation of the radial head. From theoretical and clinical considerations, the authors concluded that open reduction with rigid internal fixation of ulnar fracture and stable reduction of radial head should be the treatment of choice for Monteggia fractures.

Adolescent↗

PubMed1993

Squamous cell carcinoma complicating tibial osteomyelitis treated with local wide excision and staged microvascular reconstruction.

Squamous cell carcinoma is a complication of chronic tibial osteomyelitis treated with limb-preserving surgery. A 61-year-old man with 42-year history of chronic osteomyelitis of the left tibia was found to have malignant change. A curettage procedure was performed by a general surgeon. He then was referred to the osteomyelitis service; local wide excision was followed by staged microvascular latissimus dorsi muscle flap and fibular osteoseptocutaneous flap transfer. The patient remains well 36 months later with no clinical or radiologic evidence of local recurrence or distant metastasis. This kind of limb-sparing treatment is an excellent alternative treatment for malignancy.

Carcinoma, Squamous Cell↗

PubMed1993

Effect of dynamization of a static interlocking nail on fracture healing.

A retrospective study was done of 22 patients with complex femoral (11) and tibial (11) shaft fractures treated with static interlocking nailing followed by dynamization, which was carried out on average 7.8 months later. The success rate was 54% with no significant difference between the healing of femoral and tibial fractures. The follow-up was at least 2 years. The interval from nailing to dynamization did not correlate with the success rate; the longest interval associated with successful healing was 20 months. The authors found that static interlocking nailing without dynamization can still produce a high union rate, and if there is sparse callus formation during the healing process, indicating low osteogenesis, dynamization will result in fracture union in only half the cases. To improve the union rate, cancellous bone grafting may be necessary.

Adolescent↗

PubMed1993

Treatment of segmental femoral shaft fractures.

In a prospective study, 35 segmental femoral shaft fractures were treated either with closed intramedullary nails (most were Grosse-Kempf interlocking nails) or an open method technique (most were open Küntscher nails with supplementary wires). The follow-up period was at least one year. There was an 82.9% (29/35) union rate and a union period of 6.1 +/- 1.9 months. Knee range of motion was on average 125 degrees. Although there was no statistical difference, the closed intramedullary nailing group showed superiority to the open method group. Complications were not particularly different from those in other type fractures, but could be managed better. Closed nailing technique can be improved with training and experience. Whenever possible, with adequate indications, closed intramedullary nailing is better than open treatment for segmental femoral shaft fractures.

Adolescent↗